Severe head injury
Severe head injury
Overview
Severe head injuries need urgent medical assessment as there’s a risk of serious permanent brain damage.
It can be hard to tell the difference between a minor and a severe head injury.
Read about minor head injuries
Common Symptoms
Symptom information is not available for this condition yet.
Emergency Warning Signs
Call 999 straight away if you or someone else has a head injury and any of the following is true:
- They do not respond to their name or to a gentle rub on the chest
- They cannot stay awake
- They have had a seizure (fit)
- They fell from a height, such as 5 or more stairs
- They are having trouble with their senses, such as loss of hearing or double vision
- They have numbness or weakness in any part of the body
- They are struggling to walk, keep their balance, speak, write, or understand other people
- They hit their head with great force, for example being struck by a car
- There is a head wound with something lodged inside it, such as glass
- There are signs that the skull is damaged, such as a dent in the head
- They have severe neck pain or cannot move their head
Go to A&E (the hospital emergency department) if you or someone else has a head injury and any of the following applies:
- They are confused, or were knocked out for any length of time
- They have vomited
- They have a headache that keeps going and is not eased by painkillers
- They are behaving unusually, for example being very irritable or crying more than normal
- They have lost their memory (amnesia)
- They are intoxicated from alcohol or recreational drugs
- They have a blood clotting disorder (haemophilia) or take blood-thinning medicine (such as warfarin or apixaban)
- They have had brain surgery in the past
- They have a large bruise or wound on the head or face
- They have a black eye
- Blood or clear fluid is coming from their ears or nose
- There is bruising behind their ears
- The injury was not an accident, for example if someone has deliberately hurt a child
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
Call 999 straight away if you or someone else has a head injury and any of the following is true:
- They do not respond to their name or to a gentle rub on the chest
- They cannot stay awake
- They have had a seizure (fit)
- They fell from a height, such as 5 or more stairs
- They are having trouble with their senses, such as loss of hearing or double vision
- They have numbness or weakness in any part of the body
- They are struggling to walk, keep their balance, speak, write, or understand other people
- They hit their head with great force, for example being struck by a car
- There is a head wound with something lodged inside it, such as glass
- There are signs that the skull is damaged, such as a dent in the head
- They have severe neck pain or cannot move their head
Go to A&E (the hospital emergency department) if you or someone else has a head injury and any of the following applies:
- They are confused, or were knocked out for any length of time
- They have vomited
- They have a headache that keeps going and is not eased by painkillers
- They are behaving unusually, for example being very irritable or crying more than normal
- They have lost their memory (amnesia)
- They are intoxicated from alcohol or recreational drugs
- They have a blood clotting disorder (haemophilia) or take blood-thinning medicine (such as warfarin or apixaban)
- They have had brain surgery in the past
- They have a large bruise or wound on the head or face
- They have a black eye
- Blood or clear fluid is coming from their ears or nose
- There is bruising behind their ears
- The injury was not an accident, for example if someone has deliberately hurt a child
Diagnosis
Anyone with a severe head injury should be taken to a hospital emergency department straight away.
The doctors and nurses treating you will deal with any life-threatening injuries first. Once you are stable, they will ask you some questions. Your answers help them work out how serious the injury is and how best to treat it.
If someone saw the accident happen, it helps if they come to the hospital with you so they can describe what happened.
Assessing your injuries
A doctor will check how well your brain is working using the Glasgow Coma Scale (GCS). This is a way of measuring how serious a brain injury is. It looks at whether you can open your eyes, speak, and move your body.
You may be given a computerised tomography (CT) scan. This creates a detailed picture of the inside of your head. It shows whether there is any bleeding, bruising or swelling in the brain.
Skull X-rays are no longer used for this, because they cannot show whether the brain itself has been damaged.
If a person is confused, they may find it hard to lie still for a CT scan. In that case, they may be given an anaesthetic so the scan can be done safely and so the brain injury does not get any worse.
Reduced consciousness
Some people who suffer a severe head injury go into a state of reduced consciousness. This can mean confusion, drowsiness, or coma.
It can last for a few days, weeks, or even years. It can also be caused by other things, such as alcohol or drugs.
Depending on the cause, a person may recover partly or fully from reduced consciousness.
If someone is in a state of reduced consciousness, the medical team looking after them can sometimes give more information about:
- their current condition
- how likely they are to recover
Treatment
Depending on the injury you have and what the doctors find when they examine you, you may be:
- admitted to hospital for more tests and treatment
- allowed to go home after the examination
- sent home with advice to come back for follow-up visits at a neurology centre or head injury clinic near you
Admission to hospital
If you are admitted to hospital, the treatment you get will depend on your injuries.
Wounds
Wounds on the head often bleed a lot, especially if you take blood-thinning medicines (such as warfarin or apixaban).
Any cuts or grazes on your head will be treated to stop further bleeding and prevent infection. If there is anything stuck in the wound, such as broken glass, it will need to be taken out.
Deep or large cuts may need to be closed with glue, stitches or staples until they heal. A local anaesthetic may be used to numb the skin around the cut so that you do not feel any pain.
Brain injuries: observation
If you need to be kept under observation, the doctors and nurses looking after you will regularly check:
- how conscious and alert you are (using the GCS scale)
- the size of your pupils and how well they respond to light
- how well you can move your arms and legs
- your breathing, heart rate, blood pressure, temperature and the level of oxygen in your blood
This gives the medical team a bedside picture of how your brain injury is progressing.
Brain injuries: neurosurgery
Neurosurgery means any type of surgery used to treat problems of the nervous system (the brain, spinal cord and nerves). Most head injuries heal on their own and do not benefit from neurosurgery.
If surgery is needed, a neurosurgeon (a specialist in brain surgery) may talk to you or your family first.
However, some problems need urgent treatment. This means there may not be time to discuss the surgery before it is done. In such cases, your surgeon will talk through the operation with you or your family afterwards.
Someone who has neurosurgery is likely to need close monitoring after the operation, followed by a long period of rehabilitation.
Skull fractures
Your skull may be fractured in a head injury. Skull X-rays are of very limited use because they give little information about injury to the brain. Instead, a CT scan will help show how serious the injury is.
Most skull fractures heal on their own, especially if they are simple, straight-line fractures. Healing can take many months. You may have a headache for a few weeks. This should ease with ordinary painkillers available from a pharmacy without a prescription.
Complications
A severe head injury can cause a great deal of damage, so serious complications can follow. Some of these may be permanent.
Possible complications include the following.
The brain and the lining around it can become infected. This is called meningitis. You may be offered a vaccination to help prevent it.
Brain injury can happen for many reasons, and it may be temporary or permanent. It is hard to predict exactly how a brain injury will affect someone, but the effects could include:
- headaches and tiredness
- problems with memory
- difficulty moving, keeping your balance, or with co-ordination
- loss of your sense of taste or smell
- changes in your vision, including blind spots
- difficulty thinking, processing information and solving problems
- difficulty with speech and communication
- changes to your usual feelings and behaviour
- aggression or loss of inhibitions
- epilepsy
Some people go on having the symptoms of concussion for a long time after the original injury. This is known as post-concussion syndrome.
Going home
Once you have recovered enough to leave hospital, you will need someone to take you home. You should not drive until you have fully recovered.
If you are sent home less than 24 hours after the injury happened, someone will need to stay with you until those 24 hours have passed. This is so that any problems that appear can be spotted quickly.
You may be advised to stop taking blood thinning medicine for a short time.
Do not stop taking any prescribed medicine without first checking with your doctor or another healthcare professional. Stopping on your own could make you very ill.
Follow-up appointments and rehabilitation
You may be advised to see your doctor in the week after you leave hospital, so they can check how you are coping.
You may also be given a follow-up appointment at a head injury clinic. This will usually be with a specialist in head injuries.
Depending on your injury, you may be offered different kinds of treatment to help you recover. These could include:
- physiotherapy, to help with physical problems such as weakness, stiffness or poor co-ordination
- occupational therapy, to help if you are struggling with everyday tasks
- speech therapy
- psychological therapy, to help you cope if the injury has affected your mental wellbeing
Getting support
Every brain injury is different. It is a good idea to find out more about the possible effects and about the rehabilitation techniques available. A number of charities and organisations may be able to help, including:
- Brain and Spinal Injury Centre (BASIC)
- Brain and Spine Foundation
- Child Brain Injury Trust
- Headway